Provider Demographics
NPI:1831346386
Name:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:256-259-5313
Mailing Address - Street 1:3840 GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-5211
Mailing Address - Country:US
Mailing Address - Phone:256-844-4975
Mailing Address - Fax:256-844-4978
Practice Address - Street 1:3840 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-5211
Practice Address - Country:US
Practice Address - Phone:256-844-4975
Practice Address - Fax:256-844-4978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ALABAMA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-26
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL105198Medicaid
AL011953Medicare PIN